Citalopram is an antidepressant in the class of antidepressants called selective serotonin reuptake inhibitors. Citalopram reviews will cover various topics regarding the medication citalopram including its FDA approved indications, some additional non-FDA approved uses, citalopram side effects, the various citalopram dosages, and other potential topics of interest.
Citalopram first came to market under the brand name Celexa. Citalopram has FDA approval for the treatment of major depression, but is also frequently used to treat anxiety and sometimes for obsessive-compulsive disorder. The typical starting dose of citalopram is 20 mg daily all of sometimes physicians will prescribe a lower dose for example 10 mg daily for the first week or two in order to minimize citalopram side effects and then increase patients to the typical starting dose of 20 mg daily. The maximum daily dose of citalopram is 40 mg daily as recent FDA alerts have noted potential cardiac arrhythmias with higher dosing.
Citalopram has a medium half-life when compared other search on a reuptake inhibitor antidepressants. One of the common problems with citalopram use is citalopram withdrawal, also called the SSRI discontinuation syndrome, and the shorter the drug half-life among the SSRI class of medications the higher the incidence and more frequent and severe the SSRI discontinuation syndrome seems to be. This syndrome is frequently manifest by the disequilibrium sensation and sometimes by electric shock type sensations especially in the head and shoulders area. The sooner we quite disconcerting to patients and can generally be avoided by gradual discontinuation of the medication.
As with most SSRI medications the most common side effect of citalopram is sexual dysfunction. Most commonly this is difficulty achieving orgasm often experienced as ejaculatory dysfunction in males and as orgasmic dysfunction in females. Some patients describe a lack of pleasurable sensation in the genital organs. These sexual dysfunction problems a usually reversible and discontinuation of the medication all of the symptoms been noted in some patients to persist for months or even years after the drug is been stopped.
Usually citalopram is taken in a single daily dosage either in the morning or in the evening. Citalopram absorption from the gastrointestinal tract is not affected enough by food that taking it with or without a meal makes very much difference for most patients. Nausea is sometimes a side effect of citalopram and some patients feel it taking the medication with food reduces the incidence of nausea. If patients to notice nausea is the citalopram side effect the usually find that it decreases over time and within weeks to a month or two most patients do not note significant nausea.
Citalopram like most of the other SSRI class of medications needs to be used with caution in persons under 25 years of age. The incident suicidality seems to be increased in that age range and citalopram carries a black box warning for use in persons under age 25.
Like many chemicals citalopram has two mirror image isomers enantiomeric forms. It has been shown that the lethal isomer with the generic name of escitalopram is the primary active isomer of citalopram. This isomer has been isolated and brought to market as Lexapro. The primary advantage of Lexapro over citalopram is a slightly improvement in depression in some patients. Like most SSRIs the antidepressant effective citalopram takes from 1 to 2 weeks to begin to be noted by most patients. Lexapro may be active as early as the first week in some patients but many patients find the minor difference in speed of onset of benefits to be far outweighed by the fact the citalopram is now available as a generic drug where as Lexapro is only available the brand name drug is much more expensive. Citalopram is generally available the discount pharmacies for four dollars a month or $10 for three months where is Lexapro can cost as much as $100 per month or more. This Celexa patent expired in the US in 2003.
Citalopram is sold under several brand names the United States and Canada including Celexa. In the US generic citalopram is available in 10 mg, 20 mg, and 40 mg tablets as well as in a 10 mg per five ML elixir.
Citalopram is metabolized in the liver through the CYP2C19 pathway. In general citalopram should be used cautiously with any other SSRIs or any serotonergic medications. The serotonin syndrome although uncommon can at times be quite severe and even life-threatening. The syndrome is typically manifest by sweating, hyperthermia, tachycardia, and in severe cases by cardiovascular collapse and death.
Citalopram is considered pregnancy category C and safety in lactation are unknown.
In summary citalopram is an SSRI antidepressant with long track record of safety and use. It is generally much better tolerated than many of the non-SSRI antidepressants but has a side effect profile not dissimilar to most of the SSRI alternatives. Many of its side effects like nausea are transient and resolve with time all low sexual dysfunction side effects generally do not resolve prolonged use. Citalopram is available as an inexpensive generic and so is an excellent choice for many patients with clinical depression.
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